The childcare centers Debbie Ellis owns in Greenwood, Miss., used to serve instant potatoes, chocolate pudding and fried food. Now she has a caterer prepare meals with whole grains and vegetables. And thanks to subsidies from the U.S. Department of Agriculture, she’s actually saving money by offering her kids healthier fare. They don’t have as much fun eating it, she says, “but we do have good quality.”

There have been a lot of stories this year about the USDA’s new nutrition requirements for school lunches, which started to kick in this fall. But less attention has been paid to places like Mississippi – which has the highest rate of childhood poverty and childhood obesity in the U.S. – where efforts are underway to help kids form better eating habits before they even reach elementary school.

Childcare centers are in a unique position to combat the problem since obesity usually begins between the ages of 5 and 6, according to the American Academy of Child and Adolescent Psychiatry. That’s why it’s essential to introduce children to a healthy diet as early as possible, says Geraldine Henchy, director of nutrition policy at the Food Research and Action Center in Washington. “They’re in childcare the majority of working days, and that’s where they’re really going to get nutrition and learn good eating habits.”

The new menus at Ellis’s daycare centers are approved by the federally funded Child and Adult Care Food Program, which reimburses centers for the cost of serving children a more nutritious diet. Ellis enrolled her two centers six years ago and, as a result, is saving more than $1,600 on food each month. But despite the obvious health and financial benefits, less than half of childcare centers across the U.S. participate in the program, which the USDA has acknowledged can place an undue burden on childcare centers.

To enroll, directors must attend two days of training; in Mississippi, these are usually held in Jackson, which is more than 100 miles away from Greenwood and other low-income towns in the Mississippi Delta. Then comes a trial period, monitored by the state. Afterwards, providers must submit daily attendance records, meal logs, and grocery receipts in order to get reimbursed.

Participating daycare centers have to place youngsters in one of six age groups, and since each age group requires different types and amounts of food, even serving something as simple as a smoothie can be a complicated process. A four-page memo released in July details what needs to be in the drink to qualify for reimbursement, the rates for which also differ by meal and by a child’s family income.

Furthermore, the program only covers the cost of food if the child shows up to eat it. If a youngster does not attend on any given day, providers must swallow the costs. The same is true for childcare centers that make a mistake, such as giving a child the wrong food; they too will owe money.

“Your thought is, I don’t want to deal with another agency and red tape,” said Donna Nicholson, owner of Kids Konnection in Richland, Miss. The childcare center has been open for 16 years, but did not enroll in the 44-year-old food program until April. Why did Nicholson wait so long? She says that the paperwork involves a lot of math, and she is nervous about making mistakes that would prevent her from being reimbursed.

Hot dogs and potato chipsCenters that don’t participate in the federal program have been known to serve more affordable, but unhealthy meals of hot dogs, chicken nuggets, potato chips and fruit punch. In Mississippi, centers are required to submit menus to the state Department of Health whether or not they participate, but nutrition advocates say no one monitors them.

“These are small centers with very limited resources, just frightfully limited resources,” said Warren Yoder, executive director of the Public Policy Center of Mississippi. “They’re feeding children a very inadequate diet.”

In 2007, a federally commissioned group of experts attempted to simplify the most cumbersome of the requirements. Some of these recommendations were put in place three years later by the Healthy, Hunger-Free Kids Act.

But even with these improvements in place, “it is extraordinarily difficult for a small rural center in an underdeveloped area without much administrative capacity,” said Yoder.

“I think we’ve probably gotten as far as we can go,” he said. “And now, we’ve got to look for another model to make [participation] happen.”

In 2011, only about 38 percent of Mississippi’s 1,800 child care centers participated, even though nearly all were eligible, according to Lenora Phillips, who directs the program for the Mississippi Office of Healthy Schools. Although participation rates in Mississippi have increased 93 percent since 1996 — the year welfare reform created eligibility guidelines for the program — it’s far less than advocates had hoped. Nationally, participation rates have only increased 59 percent over the same period.

Even more discouraging are participation rates for family daycare homes — largely unlicensed programs that do not have to comply with childcare center regulations — which have plummeted in Mississippi and across the country. In a 2003 memo, the USDA attributed this to complicated changes in the program. Since 1996, the year these changes were implemented, the number of family daycare homes enrolled in the food program has dropped nearly 60 percent.

A scattered but growing network of Mississippi non-profits has been leading the efforts in the state to bolster participation, by convincing centers of the federal food program’s value and supporting them through administrative tasks.

The need to improve nutrition is urgent in Mississippi, where more than two-thirds of adults could be obese by 2030 if current trends continue, according to a recent report by Trust for America’s Health and the Robert Wood Johnson Foundation.

Obese children may face long-term health problems and are at higher risk of social, psychological and academic problems, including lower math scores.

A report released in early September suggests that recent school-based efforts to combat childhood obesity in the state have been relatively successful. In 2006, Mississippi established nutritional standards for food sold in school vending machines. A year later, a state law was passed requiring public schools to provide more physical activity time. Since then, obesity has decreased 13 percent for school-aged children.

A complex programIn Leland, a town where 67 percent of children under five live in poverty, Deloris McWright works to boost enrollment in the federal program. McWright has helped eight centers in the Mississippi Delta — the poorest part of the state — make it through the application process; seven more are on a waiting list for her support.

But in a state where the median income is about $24,000 — and even lower for single parents — thousands of low-income families in the state cannot access quality child care, much less ensure their children eat nutritious food. Only 35 percent of working families who qualify for federally subsidized childcare are being served, said Carol Burnett, director of the Mississippi Low-Income Child Care Initiative.

McWright thinks better communication about the financial and nutritional advantages of participating would encourage other centers to enroll. She still owns her own center and spends time every morning making sure all is running smoothly, even though it’s not easy.

“It is a passion for me because I know how hard it was for me when I started,” she said.

Annie Gilbertson of the Southern Education Desk, a consortium of public media stations reporting on education issues in the south, contributed to this story, which was produced by The Hechinger Report, a nonprofit, nonpartisan education-news outlet based at Teachers College, Columbia University.

I think the foods at school has come a long way. Parents are the ones to be held accountable of what their kids eat at home. At school they eat once a day plus a few snacks here and there. Overall, I think the schools do a great job of promoting healthy eating.

Higher rates of obesity linked with highest poverty rates is not suprising; fresh foods, fresh vegetables, organic foods, lean meats, all these things are expensive and not really feasible on a low budget. You can feed and fill up a lot more kids on pasta, hamburger, fishsticks, rice, biscuits, etc. than what you would pay for a bag of oranges, etc.